Burns:  Injury to tissues caused by the contact with heat, flame, chemicals, electricity, or radiation.  First degree burns show redness; second degree burns show vesication (blisters); third degree burns show necrosis through the entire skin.  Burns of the first and second degree are partial-thickness burns, those of the third are full-thickness burns.

A major burn necessitates painful treatment and a long period of rehabilitation.  Often fatal or permanently disfiguring, it can cause both emotional and physical incapacitation.

Cause: Thermal burns, the most common type, can result from residential fires, motor vehicle accidents, playing with matches, improperly stored gasoline, space heater or electrical malfunctions, scalding accidents, kitchen accidents, or child abuse.

Chemical burns can result from contact with or ingestion, inhalation, or injection of acids, alkalis, or vesicants.

Electrical burns may result from contact with faulty electrical wiring or with high-voltage power lines, or from young children chewing on electric cords.

Friction or abrasion burns result from harsh rubbing of skin against a coarse surface.

Sunburn results from excessive exposure to sunlight

Symptoms:

Varies depending on severity and depth of burn--Although most burns are a combination of different degrees and thickness

First degree burn:  Damage is limited to the epidemics, causing erythema (redness) and pain

Second degree burn:  The epidemis and part of the dermis are damaged, producing blisters and mild to moderate edema and pain

Third degree burn:  The epidemis and dermis are damaged.  No blisters appear, but white, brown, or black tissue and thrombosed vessels are visible

Fourth degree burn: Damage extends through deeply charred subcutaneous tissue to muscle and bone

Another way to assess burns is to estimate the size of a burn.  Size is usually expressed as the percentage of body surface area (BSA) covered by the burn.  Called The Rule Of Nine Chart:  a correlation of the burn's depth and size permits an estimate of its severity.

Major:  Third degree burns on more than 10% of BSA; second degree burns on  more than 25% of adult BSA (more than 20% in children); burns of hands, face, feet, or genitalia; burns complicated by fractures or respiratory damage; electrical burns; all burns in poor risk patients.

Moderate:  Third degree burns on 2% to 10% of BSA; second degree burns on 15% to 25% of adult BSA (10% to 20% in children).

Minor:  Third degree burns on less than 2% ;of BSA; second degree burns on less than 15% of adult BSA (10% in children)

Other important factors:

Location:  Burns on the face, hands, feet, and genitalia are most serious, because of possible loss of function

Configuration:  Circumferential burns can cause total occlusion of circulation in an extremity as a result of edema.  Burns on the neck can produce airway obstruction, whereas burns on the chest can lead to restricted respiratory expansion

History of complication medical problems: Disorders that impair peripheral circulation, especially diabetes, peripheral vascular disease, and chronic, alcohol abuse

Other injuries sustain at the time of the burn

Patient age:  Victims under age 4 or over age 60 have a higher incidence of complications and, consequently, a higher mortality

Pulmonary injury can result from smoke inhalation

Burns involving breathing difficulty

Burns covering more than one body part

Burns to the head, neck, hands, feet, or genitals

Burns (other than a very minor one) to a child or elderly person

Burns resulting from chemicals, explosions, or electricity

Check the scene and the victim

Send someone to call for an ambulance if necessary

Stop the burning.  Put out flames and remove person from source of the burn

Cool the burn.  Use large amounts of cool water.  Do no use ice or ice water except on small surface burns

Apply soaked towels, sheets, or other wet cloth to the face or other areas that cannot be immersed

Keep cloth cool by adding more water

Cover the burn.  Use dry, sterile dressings or a clean cloth.  Loosely bandage dressing in place ot prevent infection and reduce pain or cover burned area with dry sheet

Sunburn:  Cool the burn

Protect from further damage by staying out of sun or wearing a protective lotion

Protect unbroken blisters with loose bandages and keep broken blisters clean to prevent infection

Electrical Burns: Check the scene and the victim

Send someone to call for an ambulance if necessary

Never go near a victim until the power is turned off

If a power line is down, wait for the fire department or power company

Check breathing and pulse if person is unconscious.

Give rescue breathing or CPR if needed

Do not move person unnecessarily because there may be internal injuries

Check for possibility of two wounds; entrance and exit burns

Do not cool burn

Cover burn with dry, sterile dressing

Chemical Burns:

Send someone to call for an ambulance, if necessary

Flush both skin and eyes with large amounts of cool running water until ambulance arrives.  Always flush away from the body

Remove clothing and jewelry that may trap chemical against the skin or on which chemicals may have spilled

Smoke Inhalation:

Move the person to fresh air

Send someone to call for an ambulance

Check breathing and pulse

Support the person in the position in which it is easiest to breathe

If person is unconscious, place on side and monitor breathing closely